Comparison of middle-molecule clearance between convective control double high-flux hemodiafiltration and on-line hemodiafiltration.

Hemodiafiltration (HDF) is now a well-recognized treatment modality for end-stage renal disease (ESRD) patients. It provides superior characteristics over conventional hemodialysis in many respects. On-line HDF, however, which has been mainly used in clinical practice, requires a special machine. Interestingly, the recently innovated convective-control double high-flux hemodiafiltration (CC-DHF) machine can provide HDF treatment with an adjustable convection rate by using the conventional volume-controlled dialysate flow hemodialysis machine in a modified way. The present study was conducted to compare the efficacy of CC-DHF compared to on-line HDF in terms of middle and small solute clearances in 12 stable, chronic hemodialysis patients who underwent hemodialysis three times a week for at least 6 months. The results showed that the beta 2-microglobulin (beta 2M) removal represented by the beta 2M clearance in CC-DHF was comparable to that in on-line HDF (112.4+/-17.0 vs. 119.4+/-15.5 ml/min respectively, NS). Also, the beta 2M reduction ratio in the CC-DHF group did not differ from the on-line HDF group (85.5+/-4.2% vs. 86.1+/-6.7%, NS). With regard to small solute clearances, the values of single-pool Kt/V and phosphate clearance did not differ between CC-DHF and on-line HDF groups. In conclusion, CC-DHF provides removal of beta 2M and small molecule uremic toxins that is comparable to on-line HDF. An on-line HDF machine may not be available in all hemodialysis centers, whereas CC-DHF can be easily set up, with proper precautions regarding the fluid quality. Therefore, CC-DHF can provide the benefits of convective therapy to patients in situations where use of an on-line HDF machine is limited.

Correlations between antinucleosome antibodies and anti-double-stranded DNA antibodies, C3, C4, and clinical activity in lupus patients.

OBJECTIVE: To examine the correlations between antinucleosome antibodies and anti-double-stranded (ds) DNA antibodies, complement (C) 3 and 4 levels, and clinical activities in SLE patients. METHODS: Antinucleosome antibodies and anti-dsDNA antibodies were detected by enzyme-linked immunosorbent assays (ELISA). The levels of C3 and C4 were measured by nephelometry. Clinical activities were determined by SLE Disease Activity Index (SLEDAI). RESULTS: Of 65 SLE patients, the prevalence of antinucleosome antibodies were higher than anti-ds DNA antibodies (52.3 vs 36.9%, respectively, p < 0.05). Similar results were obtained in 45 active SLE patients, 64.4% for antinucleosome antibodies and 46.7% for anti-ds DNA antibodies. Of 34 patients lacking anti-ds DNA antibodies, 16 (47.1%) were shown antinucleosome antibodies. Activity of antinucleosome antibodies was significantly correlated with the SLEDAI scores and inversedly correlated with the C3 levels but not with the C4 levels. CONCLUSION: Antinucleosome antibodies could be one of the earliest and most sensitive markers in diagnosis of SLE, particularly in anti-dsDNA antibodies-negative patients. More importantly, antinucleosome antibodies is correlated with clinical activities and C3 levels.

Characterisation of sin, a potential recombinase-encoding gene from Staphylococcus aureus.

The staphylococcal beta-lactamase (Bla) transposon Tn4002 has previously been reported to have a high level of insertional specificity for a 1.8-kb region on the plasmid pSK1. Nucleotide sequences of this region and of a related region on plasmid pI9789 were determined. Sequence analysis revealed that these two plasmids contain sin, a gene whose deduced product shows similarity to a family of DNA recombinases. Southern hybridisation analysis indicated that sin is located on alpha-, beta- and gamma-families of Bla plasmids and on pSK1 family plasmids. A region of dyad symmetry located upstream from sin on pSK1 and pI9789 was identified as the site of insertions of Tn552 and Tn4002 in separate isolates.

Kinetic study of Russell's viper venom in envenomed patients.

Serum levels of Russell's viper venom in 30 patients bitten by Russell's viper were measured by an ELISA. In the initial serum samples, which were collected immediately after admission to the hospital (0.5-19 hr after the bite), venom was detected in 24 patients (80%), with levels ranging from 3 to 92 ng/ml. These levels correlated well with the patient's clinical signs. At 6-12 hr after antivenom therapy, the venom levels in most of the serum samples (21 of 24, 87%) had decreased to undetectable levels. In the remaining patients, whose serum venom levels could be detected 36-72 hr after therapy, the levels varied according to the effect of the antivenom therapy and the release of venom from a deposit at the bite site.

Convective-controlled double high flux hemodiafiltration: a novel blood purification modality.

Convective-controlled double high flux hemodiafiltration (CC-DHF) was set-up using two high flux dialyzers. The convection occurred in the first while the fluid replacement took place in the second dialyzer. The system of CC-DHF basically resembled that of hemodiafiltration. CC-DHF was performed in 9 chronic hemodialysis Thai patients who had been treated with high flux hemodialysis for at least 6 months. When compared with high flux hemodialysis, CC-DHF could provide higher Kt/Vurea (2.4+/-0.4 vs. 2.0+/-0.4, p<0.05) and beta2-microglobulin clearance (106.2+/-15.4 vs. 48.9+/-6.1 ml/min, p<0.01). Following 6-month therapy of CC-HDF, the predialysis beta2-microglobulin levels were reduced by 12.7% while the values of Kt/Vurea were consistently higher than 2.7. The quality of life consistently improved during the 6 months of CC-DHF treatment. There were no differences in clinical and technical complications between CC-DHF and high flux hemodialysis. In conclusion, CC-DHF could provide performance comparable to hemodiafiltration without the need for expensive hemodiafiltration machines.

Alpha-L-fucosidase as a serum marker of hepatocellular carcinoma in Thailand.

To evaluate the role of serum alpha-L-fucosidase (AFU) in the diagnosis of hepatocellular carcinoma (HCC), we simultaneously studied both AFU activity and alpha-fetoprotein (AFP) level in 60 patients with HCC, 60 patients with cirrhosis and chronic hepatitis each, 30 patients with other liver tumors and 60 healthy subjects. Serum AFU activity in patients with HCC (1,418.62 +/- 575.76 nmol/ml/hr) was significantly higher than that found in cirrhosis (831.25 +/- 261.13 nmol/ml/hr), chronic hepatitis (717.71 +/- 205.86 nmol/ ml/hr) or other tumors (706.68 +/- 197.67 nmol/ml/hr) and in controls (504.18 +/- 121.88 nmol/ml/hr, p < 0.05). With 870 nmol/ml/hr (mean value of controls plus 3 standard deviations) considered as the cut-off point, AFU was more sensitive (81.7 vs 39.1%) but less specific (70.7 vs 99.3%) than AFP at a level of > 400 ng/ml as a tumor marker of HCC. With both markers combined, the sensitivity was improved to as much as 82.6%. AFU activity in HCC patients was correlated to tumor size (r = 0.3529, p = 0.006) but not associated with tumor staging classified by Okuda's criteria (p = 0.1). The AFU activity in the viral hepatitis group (hepatitis B or C) was also significantly higher than in the non-viral group (p = 0.0005). We conclude AFU to be a useful marker, in conjunction with AFP and ultrasonography, for detecting HCC, particularly in patients with underlying viral hepatitis and cirrhosis.

Monospecific antivenin therapy in Russell's viper bite.

Venom antigenemia was detected in 24 out of 30 Russell's viper bites. Those who suffered clinical bleeding (N = 14) had higher venom antigenemia than those who did not. The mean value of the amount of monospecific antivenin correcting blood incoagulability was 165 +/- 59.3 ml. Consequently, the recommended treatment is 60 ml of antivenin being administered intravenously at 6-hour intervals until blood coagulability is restored. There were no serious complications after antivenin administration. Renal complication (3 cases) was the major problem following this snake bite. One patient with clinical diagnosis of central nervous system bleeding died on admission.

Development of coagglutination reagents for serological grouping of streptococci.

Coagglutination reagents for the rapid serological grouping of groups A, B, C, F and G Streptococcus have been developed. Antisera to groups A, B, C, F and G Streptococcus were raised in rabbits. After absorption with cross-reacting antigens, the specific antibodies were coated on Staphylococcus protein-A and used as group-specific coagglutination reagents. The sensitivity of the reagents for groups A, C and G Streptococcus was 100 per cent and the specificity was 100, 100, and 98.77 per cent, respectively. The sensitivity and specificity of these reagents were consistent up to 12 months, although specificity declined with longer storage. The in-house coagglutination reagents for groups A, C and G streptococcus were also tested in comparison with the commercially available Streptococcus Phadebact test and yielded almost identical results. Sensitivity of the in-house of group B Streptococcus reagent was low, while the group F reagent gave a high incidence of false positive reaction.

The synergistic effect of FC gamma receptor IIa and interleukin-10 genes on the risk to develop systemic lupus erythematosus in Thai population.

Several linkage analyses have consistently shown that systemic lupus erythematosus (SLE) susceptible genes are located on chromosome 1q21-44. In this study, two major candidate genes, interleukin-10 (IL-10) and Fc gamma receptor IIa (FcgammaRIIa), within these regions were investigated in Thai SLE patients. The genotyping of three single-nucleotide polymorphisms (promoter area: -1082, -819 and -592) within IL-10 gene and one polymorphism (change amino acid at position 131) within FcgammaRIIa gene was determined in 195 SLE patients and 159 ethnically matched controls. The RR/RH genotypes of FcgammaRIIa were found to be significantly increased in SLE patients compared with healthy controls [OR = 2.01, 95% confidence interval (CI) = 1.28-3.14, P= 0.001]. Interestingly, the synergistic effect between RR/RH genotypes of FcgammaRIIa and ACC/ACC haplotype of IL-10 in susceptibility to SLE was observed (OR = 7.84, 95% CI = 1.60-52.04, P= 0.002). In addition, the FcgammaRIIa, RR homozygotes was also strongly associated with anticardiolipin antibody production (OR = 6.09, 95% CI = 1.38-30.54, P= 0.006). The result demonstrated that ACC haplotype of IL-10 gene and FcgammaRIIa R131 polymorphism can be used as marker for genetic susceptibility and severity to SLE in Thai population, particularly individuals carrying both specific genotypes.

Clinical characteristics and prognosis of hepatocellular carcinoma: analysis based on serum alpha-fetoprotein levels.

The purpose of this study was to determine whether a relation does exist between clinicopathologic features and the prognosis of hepatocellular carcinoma (HCC) with respect to serum alpha-fetoprotein (AFP) levels at diagnosis. We reviewed the clinical data of 309 pathologically proven HCC cases divided into three groups: group 1 with normal AFP (<20 IU/mL), group 2 with moderately elevated AFP (20-399 IU/mL) and group 3 with markedly elevated AFP (> or =400 IU/mL). Of these, there were 76 (24.6%), 78 (25.2%), and 155 patients (50.2%) in groups 1, 2, and 3, respectively. We found that HCC patients with high AFP tended to have greater tumor size, bilobar involvement, massive or diffuse types, and portal vein thrombosis. Nonetheless, we could not establish a correlation between increased AFP and Okuda's stages, degree of tumor differentiation, or extrahepatic metastasis. The median survival rates in groups 1 (6 months) and 2 (7 months) were significantly longer than that of group 3 (3 months). On multivariate logistic regression analysis, positive hepatitis B surface antigen (HBsAg) status and bilobar tumor involvement represented the independent factors for predicting high AFP values. We concluded that AFP is useful not only for diagnosis, but also as a prognostic indicator in patients with HCC . However, it cannot be considered a sensitive tumor marker, particularly during the early stages in HBsAg-negative patients.